Healthcare Provider Details

I. General information

NPI: 1649369356
Provider Name (Legal Business Name): PEDIATRIC DENTAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11662 MARTIN RD
WARREN MI
48093-4588
US

IV. Provider business mailing address

11662 MARTIN RD
WARREN MI
48093-4588
US

V. Phone/Fax

Practice location:
  • Phone: 586-754-6300
  • Fax: 586-754-6407
Mailing address:
  • Phone: 586-754-6300
  • Fax: 586-754-6407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number15463
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number08056
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number10466
License Number StateMI

VIII. Authorized Official

Name: DR. MICHAEL W ORIORDAN
Title or Position: OWNER DENTIST
Credential: D.D.SM.S
Phone: 586-754-6300